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Credentialing Specialist
4 months ago
Who We Are:
SAC Health empowers our patients and their families to live vibrant and healthy lives through culturally responsive, exceptional care. Patient-centered, whole-person care. Our unique, full scope, team-based approach is what makes SAC Health the provider of choice for patients.
Top-Tier Patient Satisfaction Scores | Largest Teaching Health Center FQHC | 11 Locations offering 44 Specialties | NCQA Patient-Centered Medical Home Level 3 Certified
Multi-Site Approved for NHSC & NCLRP loan forgiveness programs - NHSC/Nurse Corps/Pediatric Specialty | HPSA Scores: Primary: 17 | Dental: 25 | Mental: 20
What We Are Looking For
Maintains and processing the initial application and reappointment process for the credentialing and privileging of the Medical Staff and providers. Accurately maintains the credentialing and privileging database information. Maintains current knowledge of the State, Federal and regulatory agencies, initial appointment and reappointment standards/guidelines. Performs routine database queries to manage expired and current items. Completes assigned reporting functions involving health plan roster and databases and transfer data, and other information assigned. Liaison between health plans and physicians and administration. Work with physicians to schedule enrollment application process.
Schedule: 5 days per week, 8 hours per day, Monday - Friday 7:30am - 4:00 pm | Location: Hospitality Lane Administrative Offices, San Bernardino, CA
ESSENTIAL FUNCTIONS AND DELIVERABLES
- Maintains an on-going system for processing the initial and re-appointment applications for the credentialing, billing and privileging of assigned medical staff and providers.
- Ensures that all application verifications and data is received, reviewed and acceptable if findings. Accurately enters information in database and timely submissions to all departments, agencies, boards and committees.
- Verify, maintain and post current and accurate data during the full board/committee process and all approvals are received within the time-frame necessary.
- Ensures strict confidentiality.
- Maintains current knowledge of and follows current legal, State, Federal, TJC, NCQA and other regulatory guidelines for the appointment/reappointment process. Runs SACHS OIG list monthly.
- Prepares required reports for all departments, agencies, boards and committees as necessary; Prepares board presentations and meeting follow-up, notifies appropriate leadership, health plans and departments of provider changes.
- Ensures proper documentation is received and maintained for the credentialing and billing processes.
- Manages expired items, notifies and processes suspensions, reinstatements according to SACHS policies and procedures.
- Processed temporary privileges on an as needed basis upon approval from the Chair/designee.
- Responsible for establishing and maintaining professional working relations with applicants, visitors, callers, business professionals, staff at all levels within the organization.
- Other duties as listed in the official job description.
QUALIFICATIONS:
- Education: High School graduate or equivalent required. BA/BS degree preferred.
- Licensure/Certification: CPMSM OR CPCS certification preferred.
- Experience: Minimum of three (3) years experience credentialing Medical and Ancillary Staff required.
- Essential Technical/Motor Skills: Computer data input- finger dexterity and keyboard, ability to reason, critically think and come to conclusions.
- Interpersonal Skills: Communicate by phone, in person and in writing with all levels of personnel, students, patients, interns, residents.
- Essential Mental Abilities: Work independently with little supervision, set priorities and accurately complete duties on time.
- Work Eligibility: Must be legally authorized to work in the United States on a full-time basis. Must not now or in the future require sponsorship for employment visas.
EEO: SAC Health is committed to fostering a diverse, equitable and inclusive work environment and is committed to being an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Full Benefits Package Effective on Your First Day
Industry Leading PTO Accrual (accrued per pay period) | Sick Leave | Paid Holidays | Paid Jury Duty, Bereavement | SAC Health Covers approximately 85% of Team Member health premium costs (may vary w/benefit plan selection) | Retirement - up to 8% employer contribution | Continuing Education and Learning Benefits | Annual Mission Trip and much more
Learn More About the Work We Do:
SAC Health's Mission: SAC Health's mission is to reflect the healing ministry & love of Jesus Christ through healthcare, education & partnerships that empower our communities to flourish.
SAC Health's Core Values: Quality Healthcare - Teamwork - Wholeness -Integrity - Compassion - Excellence - Humble Service - Respect
